Children with heart disease in Africa have little or no access to treatment of any kind, and cardiac surgical services are virtually absent, except for a handful of centres in a few of the wealthier nations. There is little reliable data concerning the prevalence of congenital or acquired heart disease in African children, but there is sufficient information to indicate that the burden of cardiac disease is hugely significant. This major non-communicable disease is largely hidden, overshadowed by the incidence of communicable diseases. The vast majority of African children with heart disease have no access to treatment.